一例外籍重症肺炎支原体肺炎分析

肺炎支原体肺炎(Mycoplasma Pneumoniae Pneumonia MPP)好发于儿童,但近年来成人病例逐渐增多,其临床表现缺乏特异性,若对其认识不足或重视不够,容易造成误诊,耽搁治疗。2005年4月,陕西国际旅行卫生保健中心收治了1例从西安星月医院转诊来的重症肺炎支原体肺炎患者。为了提高对本病的认识,现将其临床特点分析如下。     

阿奇霉素治疗呼吸道感染的药理特性与临床分析

阿奇霉素是近年来开发的大环内酯类抗生素,本品是通过阻碍细菌转肽过程,抑制蛋白质合成达到抑菌作用。我院呼吸内科自2006年2月～8月收治35例肺部疾患患者,将阿奇霉素用于呼吸道感染取得满意疗效。本文将概述阿奇霉素的药理特性及报道治疗呼吸道感染的临床资料。     

In-vitro interaction of azithromycin and fluoroquinolones against gram-positive and gram-negative bacteria

Objective: To determine the combined in-vitro effects of azithromycin plus the fluoroquinolone ofloxacin or lomefloxacin against gram-positive and gram-negative bacteria.
Methods: Fractional inhibitory (FIC) and fractional bactericidal concentration indices of azithromycin and the fluoroquinolone were determined using a microtiter-checkerboard method. Clinical isolates of Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Pseudomonas cepacia, Haemophilus influenzae, Xanthomonas maltophilia and Acinetobacter calcoaceticus were studied. Fourteen strains of S. aureus were also studied in time-kill curves with azithromycin (4 mg/L), lomefloxacin (6 mg/L) and the two in combination.
Results: No synergism or antagonism was found in inhibitory assays. However, bactericidal assays revealed antagonism with some strains of S. aureus, S. pneumoniae, X. maltophilia, A. calcoaceticus, P. aeruginosa, P. cepacia, K. pneumoniae and E. coli. Kill-curve results with 14 strains of S. aureus showed no antagonism with four strains of methicillin-resistant S. aureus (MRSA), and antagonism with one strain of MRSA and seven methicillin-susceptible S. aureus (MSSA).
Conclusions: In-vitro exposure to combinations of azithromycin and a fluoroquinolone does not produce a synergistic effect. Antagonism was found in bactericidal assays against some gram-negative bacteria and MSSA; caution is therefore recommended in the use of macrolides and quinolones against these organisms.     

Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study

This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12-16) or at the end of study (EOS; day 28-35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP.     

红霉素、阿奇霉素联合短程治疗小儿支原体肺炎临床研究

目的探讨红霉素、阿奇霉素联合短程和红霉素、阿奇霉素常规治疗小儿肺炎支原体肺炎,是否具有相同的疗效,并比较两种方案的安全性。方法180例肺炎支原体肺炎患儿随机分为两组,观察组80例,静脉滴注红霉素30mg·kg-1·d-1后同时口服阿奇霉素10mg·kg-1·d-,连续3天。对照组100例静脉滴注红霉素30mg·kg-1·d-1,连续7天后改为口服阿奇霉素10mg·kg-1·d-,连续3天。详细记录症状、体征、X线等及复查肝功能。结果观察组与对照组在治疗后3天,两组均能较好地控制发热、咳嗽等症状,治疗2周后X线检查病灶均基本吸收,疗效无显著差异(P>0.05)。结论对小儿肺炎支原体肺炎,红霉素、阿奇霉素联合短程与红霉素、阿奇霉素常规治疗疗效无差异,安全性相同。但前者既可缩短患者住院时间,减少用药频率,同时可减轻患儿家庭经济负担。     

红霉素环11,12-碳酸酯的体外抗菌活性研究

目的评 价红霉素环11，12-碳酸酯的体外抗菌活性。方法 采用琼脂平皿二倍稀释法测定国产和进口红霉素环11，12-碳酸酯对临床分离致病菌的体外抗菌作用，并与红霉素、罗红霉素、克拉霉素、地红霉素、阿奇霉素和乙酰螺旋霉素进行了比较。结果 国产和进口红霉素环11，12-碳酸酯对579株临床分离菌的抗菌活性相近，对革兰氏阳性菌和厌氧菌的抗菌活性比红霉素强2～8倍，优于罗红霉素、克拉霉素、地红霉索、阿奇霉素、乙酰螺旋霉素，但对革兰氏阴性菌的抗菌活性稍弱于阿奇霉素。红霉索环11，12-碳酸酯对金葡菌显示抑菌作用，对化脓链球菌在2～4倍MIC浓度时显示杀菌作用；红霉素环11，12-碳酸酯抗金葡菌和化脓链球菌的活性随着pH的增加而增强，接种量和血清浓度对国产红霉素环11，12-碳酸酯抗金葡菌和化脓链球菌的活性无明显影响。结论 红霉素环11，12-碳酸酯具有较强的体外抗菌活性，国产红霉素环11，12-碳酸酯抗菌活性与进口相近，优于红霉素、罗红霉素、克拉霉素、地红霉素、阿奇霉素和乙酰螺旋霉素。     

阿奇霉素治疗细菌性感染的临床疗效

目的:评价注射用阿奇霉素治疗细菌性感染的有效性及安全性。方法:60例呼吸系统和泌尿系统细菌感染性疾病患者随机分为治疗组和对照组,每组30例,治疗组静滴阿奇霉素250 mg,qd,疗程5 d。对照组静滴头孢噻肟钠2 g,qd,疗程7d。结果:治疗组与对照组治疗细菌感染性疾病的有效率分别为90.0%与80.0%,两组比较无统计学差异(P>0.05);细菌清除率分别为89.3%与62.1%,两组比较有统计学差异(P<0.05);不良反应发生率均为6.7%。结论:注射用阿奇霉素治疗细菌性感染疗效高、安全性好。     

静滴阿奇霉素与红霉素对小儿支原体肺炎的临床疗效研究

目的对比静滴阿奇霉素与红霉素治疗小儿支原体肺炎疗效及不良反应。方法将131例患者随机分为A组64例和B组67例,A、B两组分别静滴阿奇霉素10mg/(kg·d)和红霉素20￣30mg/(kg·d)。观察临床治愈率、有效率及不良反应率,并对结果进行统计学分析。结果临床治愈率、有效率A组分别为57.81%、93.75%,B组分别为37.31%、73.13%;不良反应发生率A组为10.93%,B组为43.28%,均有显著性差异。结论前者疗效较后者好,不良发生率少。     

长期小剂量阿奇霉素治疗慢性阻塞性肺疾病的初步研究

目的研究长期小剂量阿奇霉素治疗对慢性阻塞性肺疾病(COPD)是否有疗效。方法选择稳定期COPD病人65例,随机分成两组,治疗组口服阿奇霉素0.25g,每日1次,连续用药6周。对照组不用任何药。两组病人在病情加重时,临时应用茁-内酰胺类抗生素。治疗前、治疗6周后检测肺功能1s用力呼气容积(FEV1)和血浆白细胞介素(IL)-6、IL-8及肿瘤坏死因子(TNF)-琢的浓度,并记录临床症状记分。结果60例完成了试验,治疗组30例临床症状改善[治疗前(4.1±0.4)分,治疗后(3.8±0.5)分,P<0.01];FEV1也有改善[治疗前(1.68±0.23)L,治疗后(1.72±0.21)L,P<0.05];血浆IL-8浓度[治疗前(8.5±2.6)pg/ml,治疗后(8.5±2.6)pg/ml]、IL-6浓度[治疗后(7.1±2.8)pg/ml,治疗后(7.0±2.8)pg/ml]及TNF-琢浓度[治疗前(7.6±2.7)pg/ml,治疗后(7.5±2.7)pg/ml]均无明显改变(P>0.05)。对照组(30例)治疗前后各项指标差异无显著性(P>0.05),治疗期间未再见明显副作用。结论长期小剂量阿奇霉素治疗COPD患者可改善临床症状和其肺功能,且安全性好,不影响对血浆IL-8、IL-6及TNF-琢的浓度。     

弥漫性肺部感染临床诊治分析

目的 探讨分析阿奇霉素治疗弥漫性肺部感染临床治疗效果.方法 选取2010年1月-2012年12月该院收治的80例肺部感染的患者为研究对象,随机将患者分为观察组和对照组,每组40例患者,其中观察组患者采用阿奇霉素静脉滴注进行治疗,对照组患者静脉滴注阿莫西林进行治疗,观察两组患者临床疗效、不良反应率以及住院时间的差异.结果 观察组患者的临床显效率为95％,对照组患者的临床显效率为72.5％,两组患者临床治疗效果差异有统计学意义（P＜0.05）,观察组患者的临床不良反应率为7.5％,对照组患者不良反应率为20％,两组患者临床不良反应率差异有统计学意义（P＜0.05）.结论 采用阿奇霉素静脉滴注治疗弥漫性肺部感染安全有效,可有效缩短临床用药时间,提高患者治疗效果,值得在临床上应用.